The Lowdown on Cholesterol

The author of an article in a 1999 edition of FDA Consumer Magazine described cholesterol as the Jekyll and Hyde of the body: It's good because your body needs it for certain functions, but when present in excessive amounts, it can injure blood vessels and cause heart attack and stroke.

Cholesterol is a soft, fat-like, waxy substance found in the bloodstream and all of the body's cells. In its normal state, it produces cell membranes and some hormones, and serves other bodily functions. The cholesterol not made by your body comes from eating animal products like poultry, fish, eggs and whole milk, or from foods that contain transfats and saturated fats, such as palm and coconut oils and avocados. Since cholesterol and other fats can dissolve in the blood, they are transported to and from cells by carriers called lipoproteins: low-density (LDL), which is known as "bad" cholesterol, and high-density (HDL), or "good" cholesterol. HDL protects your body by carrying cholesterol away from your arteries and reduces your risk of heart attack.

Total blood cholesterol levels fall into one of three categories:

• desirable-less than 200 mg/dL;
• borderline high risk-200–239 mg/dL;
• high risk-240 mg/dL and over.

Totals may vary according to age and gender. Men, especially after age 50, tend to have higher LDL levels and lower HDL levels than do women; postmenopausal women may have higher LDL levels as a result of decreased amounts of estrogen. Genetics also play a part: If your parents had high cholesterol levels, you probably do as well. Ideally, levels should be measured every five years, or more often for men over age 45 or women over 55. In addition to determining total cholesterol levels, physicians often order a lipoprotein profile that shows the amounts of LDL, HDL and triglycerides, which gives them a better idea of heart disease risk and helps guide treatment.

According to Steven Gutman, MD, director of FDA's Division of Clinical Laboratory Devices, home cholesterol kits test only for total cholesterol, but are as accurate as tests done in a doctor's office. They should not be considered a substitute, however. If test results are elevated, says Dr. Gutman, consumers should see a doctor for more refined blood analysis.

Cholesterol levels can be controlled by eating foods low in saturated fat and cholesterol, maintaining a healthy weight, regular exercise, not smoking and following your healthcare professional's recommendations. National Cholesterol Education Program guidelines suggest at least a six-month program of diet, exercise and weight control before resorting to drug therapy. If diet and exercise are not enough to reduce cholesterol levels, patients may be prescribed statins, which have had a dramatic impact on cholesterol treatment. Statins interfere with the cholesterol-producing mechanisms of the liver and increase the liver's capacity to remove cholesterol from circulating blood. Statins have been shown to lower LDL cholesterol by as much as 60%, depending on the drug and dosage.

Following are some online resources for more comprehensive information on cholesterol:

• www.americanheart.org/presenter.jhtml?identifier=512
• https://health.howstuffworks.com/cholesterol4.htm
• www.fda.gov/fdac/features/1999/199_chol.html
• https://hin.nhlbi.nih.gov/cholmonth/.